后程加速超分割放疗联合腔内加热治疗食管癌前瞻性研究

目的探讨食管癌后程加速超分割放疗联合腔内加热的疗效。方法91例食管癌患者进入单纯后程加速超分割放疗(单放组)和后程加速超分割放疗联合腔内加热(热放组)的前瞻性随机对照研究，其中单放组44例，热放组47例。放疗前2／3疗程常规分割，1．8Gy／次，共41．4Gy，23分次，4～5周完成；后1／3疗程缩野加速超分割放疗，1．5Gy／次，2次／d，间隔6h，共27Gy，18分次；总剂量68．4Gy，41分次。热放组在常规分割期间每周腔内加热1次，共4次。结果单放组和热放组治疗结束时CR率分别为47．7％和72．3％，PR率分别为52．3％和27．8％(P=0．016)。中位生存时间单放组和热放组分别为30．3和30．6个月。1、2、3年生存率单放组和热放组分别为77．3％、57．4％、37．3％和80．5％、68．6%、46．3％(P=0．526)，1、2、3年局部控制率分别为86．3％、70．5％、56．5%、和92．4％、72．5％、65．5％(P=0．686)。单放组与热放组的3级急性放射性食管炎发生率分别为18．2％和27．6％(P=0．498)，3级急性放射性气管炎分别为11．4％和19．2%(P=0．191)。结论食管癌后程加速超分割放疗联合腔内加热的即期疗效优于单纯后程加速超分割放疗，腔内加热没有明显增加后程加速超分割放疗的毒性反应。

Late course accelerated hyperfractionated irradiation combined with intraluminal hyperthermia for esophageal carcinoma

Objective To evaluate the effect of late course accelerated hyperfractionated irradiation combined with intraluminal hyperthermia for esophageal carcinoma. Methods From March 2000 to October 2002, totally 91 such eligible patients were entered into the prospective randomized control trial of late course accelerated hyperfractionated irradiation (LCAH-, 44 patients) versus LCAH combined with intraluminal hyperthermia ( LCAH-HT-, 47 patients). Radiotherapy regimen consisted of conventional fractionation radiotherapy (1.8 ?Gy/f, 5f/w, totally 41.4 ?Gy/23fx) during the first two-thirds of the radiotherapy course, followed by accelerated hyperfractionation radiotherapy (1.5?Gy/f, 2f/d, with 6 h interval), using the cone-down fields, to a total dose of 68.4?Gy/41fx . Hyperthermia was given weekly during conventional fractionation irradiation, totally 4 times. Results The CR and PR rates were 47.7% and 72.3%, 52.3%and 27.8% in the LCAH arm and LCAH-HT group,respectively(P=0.016). The median survivals were 30.3 and 30.6 months,the 1-,2-,3-year survival rates were 77.3%,57.4% ,37.3% and 80.5%,68.6%, 46.3%(P= 0.526 ), the 1-,2-,3-year local control rates were 86.3%,70.5%,56.5% and 92.4%,72.5%,65.5% (P= 0.686 )in the LCAH group and LCAH-HT group,respectively. Grade III and severer of esophagitis were 18.2% and 27.6% in LCAH and LCAH-HT (P= 0.498 ), Grade III and severer tracheitis were 11.4% and 19.2% respectively (P=0.191). Conclusions The immediate effect of LCAH combined with hyperthermia is better than that of LCAH alone. Additional hyperthermia to LCAH does not increase the likelihood of radiation injury.